NHS England South West - Plasma Exchange Service (PLEX) in Devon & Cornwall

NHS England South West (NHSE SW) seeks Expressions of Interest (EOI) from providers who have the capability and capacity to deliver Plasma Exchange (PLEX) services in Devon and Cornwall. Plasma exchange is currently delivered in Devon and Cornwall on an ad-hoc basis. There is no existing substantive plasma exchange service within the area, so the provider would be expected to develop and mobilise all aspects of the service in collaboration with commissioners and key stakeholders. The service will complement the existing provision available in the rest of the South West region, ensuring more equitable access. This service supports the delivery of key services, particularly, but not limited to, neurology and haematology. Summary of Proposed Service The service should use and maintain the Spectra Optia® Apherisis System (using a peripheral line) to deliver PLEX as a preferred treatment of some neurological and blood disorders, and to support patients who would otherwise access Intravenous Immunoglobulin (IVIG) supplies. IVIG has finite supplies, with providers often having to rationalise their own allocation. The Peninsula PLEX service is expected to facilitate both elective and non-elective access. The commissioner's preferred model of delivery is a roving service, as it is believed that this will be the most cost-effective option for delivering a service 24 hours per day, 7 days per week across the geographic area. This approach would need to be complemented by a fixed base for staff, to deliver inpatient activity, with road links to the hospital sites in the area. As part of a fixed base, a 3 or 4 chair site would need to be established, with administrative space, storeroom and a patient waiting area. However, other models of delivery would be considered. Where patients require time-critical treatment, this must be delivered in line with NICE guidance. The Peninsula Trusts are Royal Devon University Hospital NHS Foundation Trust (FT), University Hospital Plymouth NHS FT, Torbay and South Devon NHS FT, and Royal Cornwall NHS FT. The service will need to develop effective working relationships with each hospital to: • Ensure that plasma exchange can be delivered in partnership with expert clinicians in each Trust who oversee care of the patient and prescribing of plasma exchange products and fluids • Work with each Trust to identify the best way to deliver plasma exchange to inpatients - e.g. transporting the equipment and staffing to the patient's bedside • Work with each Trust to identify the best way to deliver plasma exchange to outpatients - e.g. delivering treatment within a mobile unit for patients distant from the fixed site and/or via chairs at a fixed site The service will also need to develop links with regional and national specialist centres, e.g. University Hospital Bristol and Weston NHS Foundation Trust as lead regional centre for Thrombotic Thrombocytopenic Purpura. Population Needs The Peninsula Sub-Regional Immunoglobulin Advisory Panel (SRIAP) is undertaking a retrospective review to understand cases that would have utilised the PLEX service had it been available. Some patients also receive treatment outside of the Peninsula, e.g. Bristol and Southampton. Service Development It is anticipated that the use of Plasma Exchange will continue to increase, even as immunoglobulin supplies fluctuate. The Spectra Optia® Apherisis System also facilitates expansion of provision to other services, for example treatment for patients with sickle cell disease, where NHS England hold the commissioning responsibility. There are also studies that suggest that PLEX may be useful in the treatment of some cancers. NHS England reserves the right to incorporate this activity into this contract in the future if it deems it appropriate to do so. Mobilisation As this will be a new service, the provider will need to develop implementation plans, recruit and train staff, purchase equipment and develop Trust relationships. A pre-agreed list of conditions to be treated within the service must be developed with all key stakeholders. It is anticipated that the mobilisation period will be approximately 6 months, although this will be confirmed during the process. Contract duration and financial envelope are unknown at this stage. Additional information: The services are healthcare services falling within Schedule 3 to the Public Contracts Regulations 2015 ("the Regulations") which are not subject to the full regime of the Regulations, but are instead governed by the "Light Touch Regime" contained within Chapter 3, Section 7 of the Regulations (Regulations 74 to 77).